A healthy heart is essential, particularly to service members facing high-stress jobs throughout their careers. Lifestyle choices involving self-discipline and moderation are key to achieving a healthy heart and optimizing overall health, which result in a medically ready force.

“Heart disease kills over 17 million people a year,” according to Air Force Lt. Col. (Dr.) Eddie Davenport, chief of cardiology for the Aeromedical Consult Service of the 77th Human Performance Wing located at Wright-Patterson Air Force Base in Ohio. “[It’s] often the presenting symptom in sudden cardiac death.”

However, in a study of active-duty service members under 35 who suffered SCD, which occurs unexpectedly because of loss of heart function, premature coronary artery disease, or CAD, was the most common cause, noted Davenport. Yet, while common in asymptomatic military personnel, CAD is preventable with proper diet and exercise, he added.

This is true even for those with genetic predispositions for heart disease or those who are older. “Although some folks have the genetic predisposition to get heart disease, nobody has the genetic predisposition to die from it,” he said.

Additionally, some erroneously think CAD is a chronic disease among older people. However, 62% of Americans with cardiovascular disease are under age 65. “Heart health is deceptively simple and based on a little bit of self-discipline and a lot of moderation,” said Davenport.

“Exercise, diet, even alcohol and caffeine consumption is allowed and even likely cardioprotective in moderation,” he said, which could allow people to live healthily even into older age. “The actions you take when you are young will not only add years to your life but add life to your years.”

Some Exercise Goes a Long Way

The American College of Cardiology, American Heart Association, and Department of Health and Human Services all recommend 150 minutes of moderate-intensity aerobic exercise per week, or 75 minutes of vigorous activity and two strength-training sessions, said Davenport. “But there is data to support optimal health may be closer to twice this: About 300 minutes of moderate or 150 minutes of vigorous activity per week, which correlates to 30 to 60 minutes a day, five days a week.”

Based on his data and data seen in cardiac patients, Davenport recommends shorter-duration, higher-intensity activity. “There is a lot of data supporting the benefit of higher-intensity, shorter-duration exercise even in advanced heart failure,” he said.

Higher-intensity, shorter-duration activities such as heavy weightlifting, calisthenics, and plyometrics involve anaerobic exercise that breaks down glycogen for energy without using oxygen. Examples of these include burpees, jump squats, and sprinting while running, swimming, or cycling.

“Service members are expected to perform vigorous aerobic exercise and high-intensity training where being able to generate an optimal cardiac output may reflect on athletic performance,” said Army Lt. Col. (Dr.) John Symons, medical director of the Inpatient Cardiology Service at Walter Reed National Military Medical Center, in Bethesda, Maryland.

Data from the Air Force’s aircrew showed cardio protection with 20 to 30 minutes of higher-intensity exercise just five days a week. In comparison, noted Davenport, the data showed an increase in cardiac disease for those who exercise over one hour a day.

For strength training, Davenport recommended doing sets of push-ups, sit-ups, and pull-ups, which can be done anywhere. “Do as many as you can, then rest for a minute, then do as many as you can of another exercise, then continue this process for a minimum of 30 minutes,” he said.

You can also pick 10 machines at your gym and do three sets of 12 repetitions each, increasing the weight in each set and taking 1 minute to rest between sets. Keep all exercise – aerobic or strength – to less than an hour, he advised.

A Moderate Diet is Key

A balanced diet of moderation works best, noted Davenport. Weight management is a part of life, and caloric control with portion control should be a daily habit.

“Simply ensure you are not eating more than your metabolic needs – for most this is 1,500 to 2,000 calories a day”.

The American Heart Association recommends aiming for a diet that does not exceed 5% to 6% of calories from saturated fat. For example, if you need about 2,000 calories a day, no more than 120 of them should come from saturated fat, which is about 13 grams per day.

And although not every aspect of achieving a healthy heart is in our control, experts estimate that about 70% of clinical outcomes come from lifestyle choices and about 30% from genetics, Symons noted.

“Eating a healthy diet, getting enough exercise, getting enough sleep, maintaining a healthy weight, and avoiding tobacco use are the biggest variables service members have in their control,” he added. “Additional variables that the health care system can help with include controlling blood pressure, blood sugar, and lipid levels with medications if needed if lifestyle choices alone are insufficient.”

Heart disease in service members

Compared to the general population, military service members tend to be in better physical shape, said Symons. “The stress associated with active duty and combat in particular is speculated to possibly put military service members at higher risk over time of developing hypertension, and out of that becoming more at risk of cardiovascular disease, but the linkage is uncertain.”

However, working to achieve and maintain a healthy heart is particularly relevant to pilots since certain heart conditions that don’t get noticed on land can become symptomatic in the air due to pressure from high mental and physical demands pilots face when performing high-risk maneuvers, said Davenport.

“Aviators in particular are held to a higher standard of fitness and readiness as the complex mission sets they are expected to perform with are felt to require a higher level of fitness and readiness than the average service member,” said Symons.

In high-performance flight, for example, pilots must also be able to sustain sudden changes in pressure and altitude at speeds approaching or exceeding the speed of sound and gravitational forces up to nine times the normal pull (9Gs), said Davenport. “Modern military aircraft and now space flight push the limits of human physiology so much that any decrease in normal physiology could be detrimental.”

As a result, performing duties in flight involves paying attention to multiple complex cognitive inputs simultaneously, said Symons. “We want our aviators concentrating on their specific tasks.”

There are certain cardiac conditions such as arrhythmia – irregular heartbeat – or heart failure that do not lead to sudden incapacitation but may still lead to a decrease in performance of aircrew duties, thus decreasing safety of flight, said Davenport.

Atrial fibrillation, a type of arrhythmia, occurs when the two upper chambers of your heart experience chaotic electrical signals, said Symons. “It tends to cause palpitations, which can be distracting, and in rare cases, disabling.”

Symons, who is also chief of the Cardiac Electrophysiology Laboratory at WRNMMC, explained atrial fibrillation tends to originate in the pulmonary veins, which plug into the back of the left atrium of the heart. “Atrial fibrillation ablation [AFIB] involves creating a line of electrical block around where the veins plug into the back of the left atrium to discourage the pulmonary vein triggers from being able to escape into the left atrium and encourage atrial fibrillation.”

The procedure helps aviators by “walling off the common triggers in the pulmonary vein sleeves, modifying ganglionic plexi (nerves), which live in fat pads on the outside of the heart, and reducing the available surface area for wavelets of re-entry to organize and persist,” said Symons. In short, it disrupts the faulty electrical signals that cause the arrhythmia in the first place.

For pilots and aviators, “these lifestyle changes not only prevent sudden death but optimize our ability to fly, fight, and win,” said Davenport. “Before we can be the strongest Air Force, we must be the healthiest.”

Recognizing the signs

Though heart disease may present with obvious symptoms, such as chest pain or pressure, it can be more subtle, noted Symons. Shortness of breath with or without exertion, leg swelling, palpitations, lightheadedness, passing out, are also common signs of possible heart disease, Symons added.

Service members should pay attention to obvious symptoms such as chest pain and/or pressure and shortness of breath with exertion as well as be cognizant of getting tired easily or a sudden decrease in energy, said Davenport. For example, he said, some aircrew experienced symptoms while exercising, or after they completed a physical training test, marathon, or triathlon.

Some were discovered to have a major blockage in an artery. However, because they took action to take care of themselves, they were able to correct their high blood pressure or high cholesterol levels to continue their careers, he said. “In fact, over 90% are asymptomatic and were allowed to fly again.”

Personnel with a genetic history of heart disease do not escape their genetics, however, by making lifestyle choices to hinder heart disease they do not die or become disabled from it, like their family members might have.

Additionally, life stressors can negatively impact heart health by contributing to high blood pressure. So, focusing on a holistic health approach that includes joy, integrity, and social interaction will result in decreased inflammation and a longer life expectancy, ensuring a higher-quality life.

“Our three core values in the Air Force are integrity, service before self, and excellence in all we do,” said Davenport. “Just living out our core values is a great way to stay heart healthy.”